Organization
VITALYZEMED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARIQ DASTAGIR MD (OWNER)
(570) 205-8125
Entity
Organization
Contact information
Practice address
10531 4S COMMONS DR STE 519, SAN DIEGO, CA 92127-3517
(570) 205-8125
Mailing address
10531 4S COMMONS DR STE 519, SAN DIEGO, CA 92127-3517
(570) 205-8125
Taxonomy
Speciality
Code
Description
License number
State
207PH0002X
Hospice and Palliative Medicine (Emergency Medicine) Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
Other
Enumeration date
08/28/2024
Last updated
08/28/2024
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